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Branch and group reports
THE
SOCIETY
OF
MEDICAL
OFFICERS
OF
HEALTH
189
Branch and Group Reports disability; to reduce non-infectious disease; Southern Branch and to continue to eliminate environmental PUBLIC HEALTH TRAINING The seventh meeting o f the session was hazards. For these tasks we need knowledge held at the Millbrook Health Centre, or---child psychology; health education Southampton, on 6th April, with the skills; discussion techniques and methods; president, Dr. W. Fielding, in the chair. On physiology and disease processes; sociology; matters o f clinical and administrative epidemiological techniques; hygiene and interest, two points were discussed briefly : sanitation; and (since departments are large) bizarre reactions to smallpox vaccination staff management and administration". Professor Wofinden thought ~¢hat there and parental consent for immunisation of adolescents. It was resolved that the would always be a need for community Secretary should make enquiries regarding physicians. But would there always be a the need for parental consent for immunisa- need for assistant medical officers 9. In the recent past, the administration of hospitals tion o f young people aged I6 to 21 years. A paper was then read by Professor R. C. and clinical work in venereal disease and Wofinden, medical officer of health and tuberculosis had passed from local authoriprofessor of public health, Bristol, on ties to regional hospital boards. Ante-natal Public Health Training and Careers. In and post,natal care of mothers was being 1842, he said, Chadwick had recommended, taken over by general practitioners. In in the Report o f the Sanitary Conditions o f Bristol for many years general practitioners had worked in the local health authority the Labouring Population of Great Britain, that each area should have a full-time salaried clinics alongside the midwives and health medical officer. N o t until 1871 did the visitors; there was a common system of General Medical Council lay down rules ante-natal records for the hospitals, the for the Diploma in Public Health and it general practitioners and local authority. was 1888 before the D.P.H. became a N o w I00 family doctors were taking part statutory requirement for medical" officers in the scheme. A start was being made to o f heaRh of areas with a population of bring the general practitioner into the infant welfare clinic; this would be a slow 50,000 or more. process since there was no financial incenMany people were not aware that D.P.H. courses had changed to meet changing tive. These changes were made inevitable needs. The greatest alteration was made by the provision, under the National Health Service Act, t946, of a general when the Certificate course was introduced, with the intention o f providing a wider back- practitioner for each individual. The future ground for the ordinary assistant medical for local authority clinical work in the old officer and also for chest physicians and maternity and child welfare field was venereologists. It had not been successful, doubtful. Much of the demand for change in the since in the National Health Service chest physicians and venereologists had been syllabus for the D.P.H. had come from appointed not from public health depart- those who Yelt that the present D.P.H. d i d ments but from hospitals, and many medical not give an adequate training in medical officers o f health had required their assist- administration for the medical offcers o f ants to have a diploma either in child health the regional boards and the Ministry o f o r public health. The curriculum was being Health. Dr. Wofinden felt that the best modified continuously; n o w little environ- method of entry to public health was to mental hygiene was taught, chemistry and undertake the D.P.H. Course after some bacteriology teaching had diminished; but time as an assistant medical ot~cer. After discussion a vote of thanks to the the teaching o f subjects such as sociology, psychology and health education had in- speaker was moved by Dr. T. McL. Galloway (County Medical Officer, West Sussex) and creased. In the Report o f the Chief Medical was carried with acclamation. Officer of the Ministry of Health for 1959, STAFF HEALTH SERVICES medical offeers o f health w e r e described At the eighth meeting of the session, held as community physicians. The view of Dr. Inn MacQueen was c o m m e n d e d : "The at P r i o r s d e a n Hospital, P o r t s m o u t h , o n 10th May, routine business was dealt with main future tasks o f the health department first, and after the presentation of cases o f are to improve emotional and social health; to preserve the health and well-being o f clinical interest, :Dr. M. D. Warren, senior veterans; to support and rehabilitate persons lecturer in social and preventive medicine, handicapped b y physical, mental or social London School o f Hygiene and Tropical
190
PUBLIC
HEALTH
Medicine, read a paper on Functions and Organisation of Local Authority Staff Health Services. One and a half million people, he said, were employed by local authorities, and of these about 500,000 were ~employed by the education department. The largest authorities might employ, like the L.C.C., some 60,000; the smallest 40 or 50 people only. There was also much diversity of types of authorities; the organisation of staff health services would therefore be varied too. Much of the time of medical officers was now taken u p in routine medical examinations. These could be of three kinds: preemployment, routine re-examinations and examinations on return from sick leave. Seven main reasons were put forward for pro-employment examinations. These were: correct placement of individuals in jobs; fitness and suitability ~'or the job; the safety o f the employee and the public; to ensure that the employee did not have undue sickness absence; to advise the employer about restrictions to be placed on work undertaken; to protect the superannuation and sickness funds; and as a base line for future examination. None of these points survived scrutiny, with certain clearly defined exceptions (e.g. visual acmty in drivers); nor, where there was evidence, did the evidence support them. Epilepsy could not be detected at an ordinary examination and was admitted by patients less frequently than its "known prevalence. Fitness was best judged by simple physical tests, such as a prospective fireman being asked to carry a man across a courtyard. Intending employees could also be protected from their false image of the job as, for example, chronic bronchitics seeking work as park-keepers. In Dr. Warren's own series o f examinations, with the exception of high blood pressure and visual defects, other conditions had been elicited by the medical history alone. He advocated the use of questionnaires. A patient should be examined only i-f there was a n indication for it. P r o b a tionary periods of employment were of use in weeding out the unsuitables. Routine re-examinations h a d a limited usefulness, if a consistent standard was applied as, for example, in testing vision in elderly busdrivers. Examinations on return from sickness absences o f four weeks o r longer were most valuable, t t ensured that employees who h a d a condition which made them temporarily unfit for their job did not return too soon. Conversely, where some adjustment could be made to the working hours, it
VOL.
LXXVII
NO. 3
might help the employee to return t o work earlier. Much attention should be paid by ,the medical officer of health to the environment in which his authority's employees worked. Some had bizarre environments, such as firemen and sewer workers, where obviously they could be placed in great hazard. More mundane employment might also carry risk of injury, such as cooks and ambulancemen, who carrying great weights were liable to such injuries ,as prolapsed intervertebral discs. Workers in parks and gardens often used herbicides and insecticides, some of which, like D.N.O.C., if used without due care, could be lethal Consideration should also be given to the needs of outdoor workers, such as metermen and collectors. With the new Offices Act becoming law, it would.be incumbent on local authorities t o make their offices examples for other employers to follow. After discussion a vote of thanks to Dr. Warren for his stimulatiqg paper and to Dr. McLachlan for discussing cases and for making arrangements for the meeting was moved by Dr. P. G. Roads, medical officer of health, Portsmouth. This was carried with applause.
East Anglian Branch SUMMER O U T I N G The summer outing of the Branch was held on 23rd June, and v-as attended by 20 members and their guests. The party gathered on the beach at Yarmouth and took boat to Scrobie Sands to see the seals and sea birds. It was not possible to go ashore but the boat was able to come quite close t o the Sands and the seaJs came out t o meet the boat. Some came quite close and several members took photographs, including ciaefilms, which perhaps will be demonstrated on some future occasion. On returning t o Yarmouth t e a was taken at the Queen's Hotel, Yarmouth, and after this a small party visited the outdoor swimming pool on the front.
Dental Group A. G. M. The annual general meeting of the G r o u p was held in the Society's committee room, Tavistock House, o n 30th June. Having heard the reports of the officers o f the Group, and elected the officers f o r the ensuing year, the retiring president, Mr. L. B. C o m e r , delivered his valedictory address. He reviewed the year during which he held office and thanked the Group for having elected him, and the officers f o r their support during the year. He then
THE
SOCIETY
OF
MEDICAL
bestowed the presidential badge upon Miss Barbara Shapland, the new president, and inducted her t o the chair. In her presidential address Miss ShapIand thanked the G r o u p for having elected her. She then referred to the time when she first entered the school dental service and stressed the importance of quality in one's work rather than quantity. "Quality", she said, '" is an attitude of mind, not elaborate equipment. It is a largeness of experience and technical skill to the work in hand." She referred to the appalling state o f dental health in 1930 when public opinion was antagonistic to conservative work, but both in Worcestershire and Devon they had insisted that patients must be prepared to accept fillings as well as extractions. Great difficulty was experienced trying to persuade parents (often ignorant and apathetic) to accept treatment, but she found that the only way to persuade them was to promise that the fillings would not fall out. Gradually the acceptance rate rose, to about 80 per cent. in 1947. Great hopes had been held ,that with the coming o f the National Health Act the school service would have wider interests, but this was not fulfilled and resulted in loss o f staff and lack o f interest. However, the service had survived. When discussing the Service with colleagues, Miss Shapland said, did we make it sound interesting, exciting and worthwhile? This did not generally seem to be so. Very valuable work had been done in the past by public dental officers under conditions often very difficult. The idea o f team work in the health service sfiould be more clearly stressed, and all personnel should be shown the many means o f attacking and curing many forms of illhealth. Such a wider view would add more excitement a n d interest and new members could be recruited from the teaching schools. Mr. N e w t o n proposed a vote o f thanks which was warmly agreed. Midland Branch PRESIDENTIAL ADDRESS The first meeting of the session was held at Trafalgar House, Birmingham, oi1 4th October, 25 m e m b e r s having previously attended a luncheon at t h e White Horse Hotel. The Iaon. secretary intimated that Council had elected Drs. Cohen, Galloway, Preston and Martine t o serve on the Public Health Committee, B . M . A , but that Dr. M. A . H. Lawson, nominated a s being a medical officer in a department, had not been elected. Dr. J. S: Cookson, on relinquishing office as president, thanked t h e B r a n c h for
OFFICERS
OF
HEALTH
191
the support he had received while in the Chair and, having referred to the qualifications and experience which so fitted the president-elect for this office, proceeded to install Dr. E. L. M. M i l l a r as president of the Midland Branch for the session 1962763. Dr. Millar thanked Dr. Cookson for his remarks and referred to his outstanding success as president. For his presidential address eutitled " D o e s the Public Health Service Need Vigilantes?" Dr. Millar described certain situations in which co-operation between statutory bodies was still not fully secured while he also drew attention to expense, incurred by local health authorities, which was of a wasteful nature and which could be interpreted as designed to save the national exchequer. Although ~he ambulance service received 90 per cent. of its demands from hospitals there was a kind of blank cheque arrangement whereby there was an onus on the service to meet the demands and the local health authority to meet the cost. That being so there was a lack of incentive in the present arrangements for hospitals to ,arrange their demands in such a way as to be conducive to the most economical working. Examples were quoted of a physiotherapy department calling for patients from nearby streets at the following times on one day :---O845 (2 cases), 0900 (2 cases), 1030 (1 case), 1345 (1 case). This had involved the use of three vehicles whereas one would have sufficed to bring all the patients simultaneously. There were two periods during the day when demands upon the ambulance service were at a peak while at other times vehicles were standing idle. An expensive provision such as this (costing £400,000 a year in Brimingham) should, if possible, have a steady load. The system whereby the ambulance crews are used as hospital porters, thus immobilising their vehicles, was deplored and t h e suggestion m a d e that e a c h hospital should have a receivingand discharging room to which the ambulance would work. Earlier discharge f r o m hospital and various other measures were making a legitimate increased demand upon t h e service btit, at £I per ride per person, every avenue for economy must be explored. Details were given o f protracted negotiations with the Ministry of Health, starting early i~ !958, upon the subject o f notification o f certain ~ infectious diseases, notably measles, being no longer necessary. The Ministry was criticised for taking the view that this huge expenditure by local authorities was necessary to check upon the efficiency o f measles vaccine which may
192
PUBLIC
HEALTH
become available. The alternative suggestion was put forward that this expenditure was a means of relieving the exchequer o f an equal amount of disbursement to general practitioners. Dr. Millar similarly drew attention to the considerable cost to local health authorities from fees to general practitioners so as to secure the admission of unwilling mentallyill patients to hospital a n d also drew attention to the steadily increasing cost of supplying antigens which, at one time, were supplied free by the Ministry of Health. Another example of transfer of financial responsibility to local health authorities was the onus placed upon them in 1954 to distribute welfare foods which had hitherto been done by the Ministry of Food. It would appear that, in order to ensure the progress of the 10 year hospital development plan, the Minister was anxious to unload as much financial responsibility as he possibly could upon local health authorities, and the development by the latter o f homes for elderly mentally deranged people who hitherto had been accommodated in mental hospitals was a ease in point. Figures were given as to how the home help service and the domiciliary maternity service were substantially removing a load from hospitals. Dr. Ramage moved and Dr. Bryant seconded a vote of thanks to the President for such a thought-provoking address and this was accorded with acclamation.
West of Englmtd Branch (Southern Area) VISIT
TO
lcl
A meeting of the Southern Area of the Branch was held on 19th October, at the Brixham laboratories o f Imperial Chemical
VOL.
LXXVII
NO. 3
Industries Limited, when 26 members and 5 guests attended. Dr. Chipperfield, the director of the laboratories, gave the members a description of the re3earch work being carried out there. This includes the purification of industrial and sewage effluents and of river pollution and also the testing of anti-fouling and anti-corrosive paints for ships' bottoms. Later, the members were shown around the laboratories and saw research work being carried out. A vote of thanks was proposed by Dr. Wildman and received with acclamation by the meeting.
Home Counties Branch Visit to Brewery on 28th September, 42 members and friends from the Home Counties Branch visited Park Royal Brewery of Arthur Guinness, Son & Co., Ltd. Members were received by members of the staff and invited to sample some of the products of the Company. This was followed by a most interesting tour of the brewery. The Guinness Brewery at Park Royal was designed by Sir Giles Gilbert Scott, R.A., and its layout is adapted to the natural slope of the ground. The brewing process "flows'" from the Malt Store to the Vat House. Scrupulous cleanliness, and quiet efficiency, together with the dignity and courteousness of every dcpartment visited, was obvious. Observed too was the wonderful machinery and almost automatic processes of manufacture. Cocktails were served, after which there was an excellent lunch. Dr. A. C. T. Perkins, President, expressed the Branch's grateful thanks to the members of the staff of the Company for a very interesting and entertairfing visit.
THE MEDICAL WOMEN'S FEDERATION invites applications f o r T H E C H R I S T I N E M U R R E L L M E M O R I A L F E L L O W S H I P A W A R D , value £150, to a w o m a n medical practitioner registered in o n e of the countries of the British C o m m o n w e a l t h of Nations a n d on the British Medical Register. T h e A w a r d will b e m a d e for researcla, or undertaking of secretarial expenses of research work, o r the p u r c h a s e o f e q u i p m e n t required therefor. T h e A w a r d will b e f o r one y e a r a n d b e r e n e w a b l e for one further year. F o r m of application m a y be h a d o n request to the Secretary, T h e Medical W o m e n ' s Federation, T a v i s t o c k H o u s e N o r t h , T a v i s t o c k Square, L o n d o n , W.C.1, a n d should b e returned n o t later than April 30, 1963. It s h o u l d b e a c c o m p a n i e d b y a plan o f the p r o p o s e d subject o f research t o b e undertaken. T h e n a m e s of three referees s h o u l d b e supplied.
SOCIETY
OF
MEDICAL
OFFICERS
OF
HEALTH
189
Branch and Group Reports disability; to reduce non-infectious disease; Southern Branch and to continue to eliminate environmental PUBLIC HEALTH TRAINING The seventh meeting o f the session was hazards. For these tasks we need knowledge held at the Millbrook Health Centre, or---child psychology; health education Southampton, on 6th April, with the skills; discussion techniques and methods; president, Dr. W. Fielding, in the chair. On physiology and disease processes; sociology; matters o f clinical and administrative epidemiological techniques; hygiene and interest, two points were discussed briefly : sanitation; and (since departments are large) bizarre reactions to smallpox vaccination staff management and administration". Professor Wofinden thought ~¢hat there and parental consent for immunisation of adolescents. It was resolved that the would always be a need for community Secretary should make enquiries regarding physicians. But would there always be a the need for parental consent for immunisa- need for assistant medical officers 9. In the recent past, the administration of hospitals tion o f young people aged I6 to 21 years. A paper was then read by Professor R. C. and clinical work in venereal disease and Wofinden, medical officer of health and tuberculosis had passed from local authoriprofessor of public health, Bristol, on ties to regional hospital boards. Ante-natal Public Health Training and Careers. In and post,natal care of mothers was being 1842, he said, Chadwick had recommended, taken over by general practitioners. In in the Report o f the Sanitary Conditions o f Bristol for many years general practitioners had worked in the local health authority the Labouring Population of Great Britain, that each area should have a full-time salaried clinics alongside the midwives and health medical officer. N o t until 1871 did the visitors; there was a common system of General Medical Council lay down rules ante-natal records for the hospitals, the for the Diploma in Public Health and it general practitioners and local authority. was 1888 before the D.P.H. became a N o w I00 family doctors were taking part statutory requirement for medical" officers in the scheme. A start was being made to o f heaRh of areas with a population of bring the general practitioner into the infant welfare clinic; this would be a slow 50,000 or more. process since there was no financial incenMany people were not aware that D.P.H. courses had changed to meet changing tive. These changes were made inevitable needs. The greatest alteration was made by the provision, under the National Health Service Act, t946, of a general when the Certificate course was introduced, with the intention o f providing a wider back- practitioner for each individual. The future ground for the ordinary assistant medical for local authority clinical work in the old officer and also for chest physicians and maternity and child welfare field was venereologists. It had not been successful, doubtful. Much of the demand for change in the since in the National Health Service chest physicians and venereologists had been syllabus for the D.P.H. had come from appointed not from public health depart- those who Yelt that the present D.P.H. d i d ments but from hospitals, and many medical not give an adequate training in medical officers o f health had required their assist- administration for the medical offcers o f ants to have a diploma either in child health the regional boards and the Ministry o f o r public health. The curriculum was being Health. Dr. Wofinden felt that the best modified continuously; n o w little environ- method of entry to public health was to mental hygiene was taught, chemistry and undertake the D.P.H. Course after some bacteriology teaching had diminished; but time as an assistant medical ot~cer. After discussion a vote of thanks to the the teaching o f subjects such as sociology, psychology and health education had in- speaker was moved by Dr. T. McL. Galloway (County Medical Officer, West Sussex) and creased. In the Report o f the Chief Medical was carried with acclamation. Officer of the Ministry of Health for 1959, STAFF HEALTH SERVICES medical offeers o f health w e r e described At the eighth meeting of the session, held as community physicians. The view of Dr. Inn MacQueen was c o m m e n d e d : "The at P r i o r s d e a n Hospital, P o r t s m o u t h , o n 10th May, routine business was dealt with main future tasks o f the health department first, and after the presentation of cases o f are to improve emotional and social health; to preserve the health and well-being o f clinical interest, :Dr. M. D. Warren, senior veterans; to support and rehabilitate persons lecturer in social and preventive medicine, handicapped b y physical, mental or social London School o f Hygiene and Tropical
190
PUBLIC
HEALTH
Medicine, read a paper on Functions and Organisation of Local Authority Staff Health Services. One and a half million people, he said, were employed by local authorities, and of these about 500,000 were ~employed by the education department. The largest authorities might employ, like the L.C.C., some 60,000; the smallest 40 or 50 people only. There was also much diversity of types of authorities; the organisation of staff health services would therefore be varied too. Much of the time of medical officers was now taken u p in routine medical examinations. These could be of three kinds: preemployment, routine re-examinations and examinations on return from sick leave. Seven main reasons were put forward for pro-employment examinations. These were: correct placement of individuals in jobs; fitness and suitability ~'or the job; the safety o f the employee and the public; to ensure that the employee did not have undue sickness absence; to advise the employer about restrictions to be placed on work undertaken; to protect the superannuation and sickness funds; and as a base line for future examination. None of these points survived scrutiny, with certain clearly defined exceptions (e.g. visual acmty in drivers); nor, where there was evidence, did the evidence support them. Epilepsy could not be detected at an ordinary examination and was admitted by patients less frequently than its "known prevalence. Fitness was best judged by simple physical tests, such as a prospective fireman being asked to carry a man across a courtyard. Intending employees could also be protected from their false image of the job as, for example, chronic bronchitics seeking work as park-keepers. In Dr. Warren's own series o f examinations, with the exception of high blood pressure and visual defects, other conditions had been elicited by the medical history alone. He advocated the use of questionnaires. A patient should be examined only i-f there was a n indication for it. P r o b a tionary periods of employment were of use in weeding out the unsuitables. Routine re-examinations h a d a limited usefulness, if a consistent standard was applied as, for example, in testing vision in elderly busdrivers. Examinations on return from sickness absences o f four weeks o r longer were most valuable, t t ensured that employees who h a d a condition which made them temporarily unfit for their job did not return too soon. Conversely, where some adjustment could be made to the working hours, it
VOL.
LXXVII
NO. 3
might help the employee to return t o work earlier. Much attention should be paid by ,the medical officer of health to the environment in which his authority's employees worked. Some had bizarre environments, such as firemen and sewer workers, where obviously they could be placed in great hazard. More mundane employment might also carry risk of injury, such as cooks and ambulancemen, who carrying great weights were liable to such injuries ,as prolapsed intervertebral discs. Workers in parks and gardens often used herbicides and insecticides, some of which, like D.N.O.C., if used without due care, could be lethal Consideration should also be given to the needs of outdoor workers, such as metermen and collectors. With the new Offices Act becoming law, it would.be incumbent on local authorities t o make their offices examples for other employers to follow. After discussion a vote of thanks to Dr. Warren for his stimulatiqg paper and to Dr. McLachlan for discussing cases and for making arrangements for the meeting was moved by Dr. P. G. Roads, medical officer of health, Portsmouth. This was carried with applause.
East Anglian Branch SUMMER O U T I N G The summer outing of the Branch was held on 23rd June, and v-as attended by 20 members and their guests. The party gathered on the beach at Yarmouth and took boat to Scrobie Sands to see the seals and sea birds. It was not possible to go ashore but the boat was able to come quite close t o the Sands and the seaJs came out t o meet the boat. Some came quite close and several members took photographs, including ciaefilms, which perhaps will be demonstrated on some future occasion. On returning t o Yarmouth t e a was taken at the Queen's Hotel, Yarmouth, and after this a small party visited the outdoor swimming pool on the front.
Dental Group A. G. M. The annual general meeting of the G r o u p was held in the Society's committee room, Tavistock House, o n 30th June. Having heard the reports of the officers o f the Group, and elected the officers f o r the ensuing year, the retiring president, Mr. L. B. C o m e r , delivered his valedictory address. He reviewed the year during which he held office and thanked the Group for having elected him, and the officers f o r their support during the year. He then
THE
SOCIETY
OF
MEDICAL
bestowed the presidential badge upon Miss Barbara Shapland, the new president, and inducted her t o the chair. In her presidential address Miss ShapIand thanked the G r o u p for having elected her. She then referred to the time when she first entered the school dental service and stressed the importance of quality in one's work rather than quantity. "Quality", she said, '" is an attitude of mind, not elaborate equipment. It is a largeness of experience and technical skill to the work in hand." She referred to the appalling state o f dental health in 1930 when public opinion was antagonistic to conservative work, but both in Worcestershire and Devon they had insisted that patients must be prepared to accept fillings as well as extractions. Great difficulty was experienced trying to persuade parents (often ignorant and apathetic) to accept treatment, but she found that the only way to persuade them was to promise that the fillings would not fall out. Gradually the acceptance rate rose, to about 80 per cent. in 1947. Great hopes had been held ,that with the coming o f the National Health Act the school service would have wider interests, but this was not fulfilled and resulted in loss o f staff and lack o f interest. However, the service had survived. When discussing the Service with colleagues, Miss Shapland said, did we make it sound interesting, exciting and worthwhile? This did not generally seem to be so. Very valuable work had been done in the past by public dental officers under conditions often very difficult. The idea o f team work in the health service sfiould be more clearly stressed, and all personnel should be shown the many means o f attacking and curing many forms of illhealth. Such a wider view would add more excitement a n d interest and new members could be recruited from the teaching schools. Mr. N e w t o n proposed a vote o f thanks which was warmly agreed. Midland Branch PRESIDENTIAL ADDRESS The first meeting of the session was held at Trafalgar House, Birmingham, oi1 4th October, 25 m e m b e r s having previously attended a luncheon at t h e White Horse Hotel. The Iaon. secretary intimated that Council had elected Drs. Cohen, Galloway, Preston and Martine t o serve on the Public Health Committee, B . M . A , but that Dr. M. A . H. Lawson, nominated a s being a medical officer in a department, had not been elected. Dr. J. S: Cookson, on relinquishing office as president, thanked t h e B r a n c h for
OFFICERS
OF
HEALTH
191
the support he had received while in the Chair and, having referred to the qualifications and experience which so fitted the president-elect for this office, proceeded to install Dr. E. L. M. M i l l a r as president of the Midland Branch for the session 1962763. Dr. Millar thanked Dr. Cookson for his remarks and referred to his outstanding success as president. For his presidential address eutitled " D o e s the Public Health Service Need Vigilantes?" Dr. Millar described certain situations in which co-operation between statutory bodies was still not fully secured while he also drew attention to expense, incurred by local health authorities, which was of a wasteful nature and which could be interpreted as designed to save the national exchequer. Although ~he ambulance service received 90 per cent. of its demands from hospitals there was a kind of blank cheque arrangement whereby there was an onus on the service to meet the demands and the local health authority to meet the cost. That being so there was a lack of incentive in the present arrangements for hospitals to ,arrange their demands in such a way as to be conducive to the most economical working. Examples were quoted of a physiotherapy department calling for patients from nearby streets at the following times on one day :---O845 (2 cases), 0900 (2 cases), 1030 (1 case), 1345 (1 case). This had involved the use of three vehicles whereas one would have sufficed to bring all the patients simultaneously. There were two periods during the day when demands upon the ambulance service were at a peak while at other times vehicles were standing idle. An expensive provision such as this (costing £400,000 a year in Brimingham) should, if possible, have a steady load. The system whereby the ambulance crews are used as hospital porters, thus immobilising their vehicles, was deplored and t h e suggestion m a d e that e a c h hospital should have a receivingand discharging room to which the ambulance would work. Earlier discharge f r o m hospital and various other measures were making a legitimate increased demand upon t h e service btit, at £I per ride per person, every avenue for economy must be explored. Details were given o f protracted negotiations with the Ministry of Health, starting early i~ !958, upon the subject o f notification o f certain ~ infectious diseases, notably measles, being no longer necessary. The Ministry was criticised for taking the view that this huge expenditure by local authorities was necessary to check upon the efficiency o f measles vaccine which may
192
PUBLIC
HEALTH
become available. The alternative suggestion was put forward that this expenditure was a means of relieving the exchequer o f an equal amount of disbursement to general practitioners. Dr. Millar similarly drew attention to the considerable cost to local health authorities from fees to general practitioners so as to secure the admission of unwilling mentallyill patients to hospital a n d also drew attention to the steadily increasing cost of supplying antigens which, at one time, were supplied free by the Ministry of Health. Another example of transfer of financial responsibility to local health authorities was the onus placed upon them in 1954 to distribute welfare foods which had hitherto been done by the Ministry of Food. It would appear that, in order to ensure the progress of the 10 year hospital development plan, the Minister was anxious to unload as much financial responsibility as he possibly could upon local health authorities, and the development by the latter o f homes for elderly mentally deranged people who hitherto had been accommodated in mental hospitals was a ease in point. Figures were given as to how the home help service and the domiciliary maternity service were substantially removing a load from hospitals. Dr. Ramage moved and Dr. Bryant seconded a vote of thanks to the President for such a thought-provoking address and this was accorded with acclamation.
West of Englmtd Branch (Southern Area) VISIT
TO
lcl
A meeting of the Southern Area of the Branch was held on 19th October, at the Brixham laboratories o f Imperial Chemical
VOL.
LXXVII
NO. 3
Industries Limited, when 26 members and 5 guests attended. Dr. Chipperfield, the director of the laboratories, gave the members a description of the re3earch work being carried out there. This includes the purification of industrial and sewage effluents and of river pollution and also the testing of anti-fouling and anti-corrosive paints for ships' bottoms. Later, the members were shown around the laboratories and saw research work being carried out. A vote of thanks was proposed by Dr. Wildman and received with acclamation by the meeting.
Home Counties Branch Visit to Brewery on 28th September, 42 members and friends from the Home Counties Branch visited Park Royal Brewery of Arthur Guinness, Son & Co., Ltd. Members were received by members of the staff and invited to sample some of the products of the Company. This was followed by a most interesting tour of the brewery. The Guinness Brewery at Park Royal was designed by Sir Giles Gilbert Scott, R.A., and its layout is adapted to the natural slope of the ground. The brewing process "flows'" from the Malt Store to the Vat House. Scrupulous cleanliness, and quiet efficiency, together with the dignity and courteousness of every dcpartment visited, was obvious. Observed too was the wonderful machinery and almost automatic processes of manufacture. Cocktails were served, after which there was an excellent lunch. Dr. A. C. T. Perkins, President, expressed the Branch's grateful thanks to the members of the staff of the Company for a very interesting and entertairfing visit.
THE MEDICAL WOMEN'S FEDERATION invites applications f o r T H E C H R I S T I N E M U R R E L L M E M O R I A L F E L L O W S H I P A W A R D , value £150, to a w o m a n medical practitioner registered in o n e of the countries of the British C o m m o n w e a l t h of Nations a n d on the British Medical Register. T h e A w a r d will b e m a d e for researcla, or undertaking of secretarial expenses of research work, o r the p u r c h a s e o f e q u i p m e n t required therefor. T h e A w a r d will b e f o r one y e a r a n d b e r e n e w a b l e for one further year. F o r m of application m a y be h a d o n request to the Secretary, T h e Medical W o m e n ' s Federation, T a v i s t o c k H o u s e N o r t h , T a v i s t o c k Square, L o n d o n , W.C.1, a n d should b e returned n o t later than April 30, 1963. It s h o u l d b e a c c o m p a n i e d b y a plan o f the p r o p o s e d subject o f research t o b e undertaken. T h e n a m e s of three referees s h o u l d b e supplied.